Shoulder
A 27-year-old man was diving for a ball with his arm outstretched, he feels a pop in his shoulder and notices an obvious deformity. His shoulder is reduced in the ER, but weeks later, he reports feeling like it might “pop out” again whenever he reaches back to throw a football. What two injuries may have occurred during his initial dislocation? (what special tests are needed and why)
Hill sachs fracture and bankart lesion.
Bankart tear:
1. Apprehension Relocation (jobes), 2. Load shift, 3. Sulcus sign
Your patient presents with pain, instability, clicking and catching after grabbing the railing while falling ddown the stairs. What is your suspected diagnosis and What tests can you perform to rule this in or out?
SLAP lesion - anterior to posterior
1. Biceps load 1 2. Biceps load 2 3. O'Briens 4. Crank
A rock climber experiences sudden pain while gripping a hold. Examination reveals an inability to actively flex the DIP joint of the ring finger, despite preserved PIP flexion.
Jersey Finger
What is the most common mechanism of acute elbow instability and what may it lead to? What test can rule this in?
- Patient will typically present with a deformity of asymmetry with dorsal view of the humeral condyles.
FOOSH leading to posterolateral rotatry instability.
Positive lateral pivot shift test --> the elbow will sublux at 40-70 degrees of elbow
Patient presents with pain in the posterolateral shoulder which can not be reproduced with normal impingement or UE tests. They have weakness in infraspinatus and supraspinatus and an abnoral scapula/GH rhythm. What is their expected diagnosis and what is the treatment?
Suprascpaular nerve injury due to heave back or excessive pronation.
Treatment:
- Anti-inflammatories, surgery, medial and inferior scapular glides
your patient presents with pain in the anterior aspect of the shoulder that is aggravated by resisted elbow flexion and loss of sholder ROM. Your patient also has a positive painful arc. What is your patients possible diagnosis and what special tests are needed to rule this disorder in/out?
Biceps tendinitis/tear which can be due to overuse, SAPs, instability.
The special tests needed will be yergasons (transverse humeral ligament) , speeds, and palpation of long head of biceps.
Your patient fell directly onto his shoulder after tripping over his dog. He has tenderness with palpation, limited AROM of abduction and horizontal adduction. There is also a noticeable deformity on the anterior lateral aspect of his shoudler. What special tests should you perform to rule in your diagnosis?
AC Joint separation (at least a grade three CC and AC are torn we know from the deformity)
1. Crossed body extension 2. Crossed body adduction 3. O briens
A patient reports dorsal wrist pain radially with clicking after a FOOSH injury. what special test may you perform?
Watsons
When the UCL becomes insufficient, this bony structure takes on an increased role as a secondary stabilizer against valgus stress.
Radial head can become compressed with capitulum
Your patient presents with pain above the lateral epicondyle. The pain is reproduced with resisted forearm supination and finger extension. ROM and MMT are within normal limits with pain being the primary symptom. what is the expected diagnosis?
Radial Tunnel Syndrome
What is the difference between primary/secondary impingement?
What structures can become impinged?
What are the test for impingement?
Primary impingement is a result of soft tissue/boney changes (Usually >40) whereas secondary impingement is a result of scapular dyskinesia and RC fatigue) where the head doesn't stay centered (15-35)
Structures: Supraspinatus, LHBT, Subacromial Bursa, Coracohumeral ligament, Capsule
Tests: Painful arc, Infraspinatus, Hawkins kennedy (neer's/Yokums)
What are the classifications of rotator cuff tears?
Patients should have full passrive ROM by week 4, if they don't what may have they been missing from their program?
What strengthening should you do for RTC and what should you not do specifically not do if there is a bicep tenodesis?
Small <3cm, medium 1-3 cm, large 3-5cm, massive >5cm
Inferior glides becuase the inferior capsule will tighten up.
Submax isometrics (neutral), grip strength, static hold rotator cuff and deltoid (without compensation)
No grip strength or elbow flexion (Bicep tenodesis)
Following a basketball injury, a patient cannot actively extend the DIP joint but maintains full passive extension.
Mallet finger
What portions of the UCL forms the floor of the cubital tunnel
Posterior oblique ligament - Prevents valgus at igher levels of flexion
A patient presents with weakness of finger extension and wrist extension with tricep extension preserved. What nerve is impacted and where
Radial nerve in the radial groove
Your patient has diffuse pain that occurs with rapid movement at night when lying on their side. They have a global loss of PROM and AROM with pain at end range. Their pain is nagging with no history of injury. What is their diagnosis, stage/phase, and what is the cause/treatment?
1 and 2 joint mobs, pain relief, exercise within pain limits (middle would be LLLD)
When doing a dynamix scapular motion test you notice that the scapular is elevated and the inferior border moves medially. what nerve is impaired.. how would we know that?
We also notice on another patient that the scapular is depressed and the inerior border move laterally before 90 degrees what is the possible impairement?
1. Long throacic --> No serratus pulling forward
2. Spinal accessory --> No traps pulling up or in
A patient reports radial wrist pain when lifting their infant. Pain is reproduced with thumb flexion inside a closed fist followed by ulnar deviation.
De Quervains --> Bracing
A patient reports posterior elbow swelling after spending several hours leaning on their elbows while working at a desk.
Olecranon bursitis
Perform and describe the tests for TOS, mechanism of injury, and S/S
Sydney is lazy. ill tell you if its right lol
What is the scapular flip sign
(middle to lower trapezius → CN XI)
The medial border of scapula flips away or lifted away from the thoracic wall with resisted ER
A patient demonstrates PIP hyperextension and DIP flexion following a chronic finger injury.
Swan neck deformity
Patient has a typical presentation of medial epicondylitis with pain at the the medial epicondyle, pain with wrist flexion and pronation. The pain has been present for 7 months. How is this treated in this situation vs more acute/subacute
Chronic - Emphasize eccentrics, discontinue brace, Ice as needed
Subacute - Initiate strengthening, Continue ROM, cross friction massage, Brace with activity and ice afterward
ACute - Cold, ROM
Your patient presents with loss of MCP extension with no real sensory change. Explain the pathophysiology
compression of the deep branch, direct trauma, repetitive motion (supination).
Why? Because Extensor Digitorum and ECRB are innervated by PIN this leads to more radial deviation than extension.